Basic Benefit Description

This benefit helps pay for annual vision examinations and for glasses and contact lenses, subject to the rules of the plan. All benefits are covered once per calendar year at the amount shown below.

Eye Exam

$80

Lenses

$65 - Single vision per pair
$95 - Bifocal
$135 - Trifocal
$135 - Progressive

Contact Lenses

$125

Special Lens Treatment

$20

Frames

$80